South Central Ambulance Service NHS Foundation Trust

56 Pages·2014·1.46 MB·English

Strategic Plan Document for 2014-19

South Central Ambulance Service
NHS Foundation Trust
Strategic Plan for y/e 31 March 2015 to 2019
This document completed by (and Monitor queries to be directed to):

Name Charles Porter

Job Title Director of Finance

e-mail address [email protected]

Tel. no. for 07738480938
contact

Date 30/6/2014

The attached Strategic Plan is intended to reflect the Trust’s business plan over the next
five years. Information included herein should accurately reflect the strategic and
operational plans agreed by the Trust Board.

In signing below, the Trust is confirming that:
 The Strategic Plan is an accurate reflection of the current shared vision and strategy of
the Trust Board having had regard to the views of the Council of Governors;
 The Strategic Plan has been subject to at least the same level of Trust Board scrutiny as
any of the Trust’s other internal business and strategy plans;
 The Strategic Plan is consistent with the Trust’s internal operational plans and provides
a comprehensive overview of all key factors relevant to the delivery of these plans;
 All plans discussed and any numbers quoted in the Strategic Plan directly relate to the
Trust’s financial template submission; and
 The ‘declaration of sustainability’ is true to the best of its knowledge.

Approved on behalf of the Board of Directors by:

Name Trevor Jones
(Chair)

Signature

Approved on behalf of the Board of Directors by:

Name Will Hancock
(Chief Executive)

Signature

Approved on behalf of the Board of Directors by:
Name Charles Porter
(Finance Director)

Signature
SCAS STRATEGIC PLAN 2014-19
Executive Summary
SCAS1 is much more than a traditional (transporting) ambulance service. It is also a clinical assessment
and sign-posting service for people who are ill, injured or concerned about their health. We are
continually striving to offer the right care, first time for each individual patient.
Looking ahead, the key challenges facing SCAS are to improve the quality and effectiveness of patient
care, and to support local systems in managing rising demand, within the context of tightening finances
and increased competition. Our vision, strategic plan and the associated transformation programme are
designed to enable SCAS to rise to the challenges expected over the next five years.
Vision of SCAS in five years’ time
Services
SCAS will help people to identify and access the care that they need. Our Clinical Coordination Centres
will provide simplified access for all health and social care, whether someone is in a crisis situation or
simply booking an appointment.
SCAS will continue to save lives, with emergency responders dispatched immediately and specialist
clinical teams equipped to convey a patient to the most appropriate unit if needed. Our mobile teams
will also be available 24/7 to support people in their own homes and local communities, offering advice,
assessment, diagnostics and treatment on scene.
SCAS will make proactive welfare calls and monitor the health of people who are frail, at risk of
deterioration in their health or who suffer from mental health issues. Our clinicians will work very
closely with GPs and other community-based services to keep people safe in their own communities, and
we will help to resettle people at home following discharge from hospital.
SCAS has a ‘helicopter view’ of local systems of care. We will use this unique position to analyse demand
patterns, patient flows, clinical outcomes and service gaps. We will work with our commissioners and
partners to improve the range and availability of services offered in each local area.
SCAS plans to expand its clinical assessment, signposting and mobile healthcare services into a wider
geography. Opportunities will be assessed as they arise, on the basis of strategic fit and compatibility
with our core business, as well as clinical, operational and financial viability.
Processes
Our services will be accessible 24/7, either on the telephone or via on-line and digital services. People
will be offered high quality clinical assessment, advice and signposting to the relevant services.
We will have rapid, streamlined assessment processes, so that we can identify people in life-threatening
situations quickly and dispatch emergency clinicians immediately to scene if needed.
Our services will be underpinned by a comprehensive and up-to-date Directory of Services in each local
area, with direct access to care pathways, so that we can offer the ‘right care, first time’.
Staff in both our Clinical Coordination Centres and Mobile Teams will be able to access multi-agency care

1 South Central Ambulance Service NHS Foundation Trust is referred to as ‘SCAS’ throughout this document.
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plans and clinical records, in order to gain an understanding of individual needs and signpost patients to
the most appropriate services. Our clinicians will communicate and keep records electronically, and we
will also offer these technical facilities to mobile clinicians working for partner organisations.
Organisation
Our Emergency 999, NHS111, Healthcare Professional and Patient Transport Services will work much
more closely, so that they can share resources to accommodate peaks in demand, and so that they can
tailor the type of response to meet individual patient needs.
We will work seamlessly with GPs, with out-of-hours services either being run or hosted in our Clinical
Coordination Centres. We will also host staff with other specialist skills, for example offering advice to
people with mental health issues or enquiries about social care.
Our Mobile Teams will include clinicians with advanced practitioner skills, in order to enhance the quality
of our clinical assessment, and broaden the range of diagnostics and treatment offered on scene.
Our staff (or at least a sub-set of our staff) will work flexibly in order to accommodate the fluctuating
nature of our emergency and urgent business. Our fleet workshops will work extended hours to support
our 24/7 service and ensure that the optimal number of vehicles are available during the peak hours.
Tools
These services will be supported by a highly resilient virtual telephony platform.
They will be underpinned by a comprehensive and up-to-date Directory of Services in each local area.
All clinical and corporate processes will use electronic communication and record keeping. Our mobile
clinicians will use Electronic Patient Records and have visibility of Summary Care Records.
There will be systems in place to predict demand, to plan capacity and to schedule staff and vehicles, in
line with predicted demand.
Our fleet mix is likely to change, with a greater emphasis on cars and smaller vehicles in the future, and
this would aim to give a better patient experience.
We will make use of new technological developments, such as tele-monitoring, digital applications,
image transfer and mobile diagnostics. We will develop an integrated alert system across care agencies.
Information
Our performance scorecards will draw data from all of our systems, with options to drill down into data
by individual or team, as well as giving an overview of the organisation as a whole.
Using the NHS number as a common identifier, we will analyse the wealth of data available to us and
offer a ‘helicopter view’ of local systems of care. We will also seek to compare this data with national
and international benchmarking data.
We will analyse demand patterns, patient flows, clinical outcomes and service gaps, and we will work
with commissioners to understand service gaps and evaluate plans for improvement.
Contents
1. Declaration of sustainability
2. Market analysis and context
3. Clinical Coordination Centres
4. Mobile Healthcare
5. Patient Transport
6. Helicopter View
7. Other services
8. Strategic Plans

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1 DECLARATION OF SUSTAINABILITY

1.1 CLINICAL SUSTAINABILITY
The organisation is clinically sustainable. Nevertheless, it has identified areas for improvement and
development within its strategy.
The key uncertainties are: Mitigations
 If SCAS cannot recruit, develop and retain There is early work to design a new service model
enough clinicians, for either the Clinical and to create the associated workforce, including
Coordination Centres or the Mobile Teams, innovative training and recruitment campaigns.
there is a risk that we cannot fulfil our
We already use community first responders for
strategic intentions.
appropriate incidents, and we are exploring other
ways for volunteers, military personnel and other
emergency services to support our clinicians.
 If any reconfiguration of acute services SCAS is working closely with commissioners and
results in long journeys to emergency acute providers in any service redesign activities.
departments or specialist units, this risks
having a detrimental impact on clinical
outcomes for patients with life-threatening
conditions and associated reduction in SCAS
outcome performance.
 If there is not a sufficient range of 24/7 and SCAS is working closely with commissioners and
accessible care pathways to meet patients’ partner agencies to ensure that there is a
needs, this risks having a detrimental impact comprehensive and accessible range of pathways
on SCAS’s scope to direct patients to the available in each local systems of care, helping to
most appropriate care, with the associated highlight any service gaps and identify solutions.
risk of increased conveyance rates to
SCAS is also working with commissioners to
emergency departments.
ensure that the local Directory of Services
provides accurate and up-to-date information
about the services that are available.
 If GPs and other health providers use the SCAS is currently implementing electronic patient
electronic communication and patient records. We are also working with partner
records that are being developed, there is an agencies to gain access to summary care records.
opportunity for SCAS to make more informed
assessments of patient needs and care plans.
 With electronic communication and patient A key aspect of the strategy is to build analytical
records, there is also an opportunity to use capability and capacity, so that we can make use
better analysis of clinical performance to of the wealth of data that we have available to
identify ways to improve patient care, both analysis patient flows and service gaps.
by SCAS and across local systems of care.
The intention is to use this analysis to gain a
better understanding of our performance and
also to offer a ‘helicopter view’ of local systems.
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1.2 OPERATIONAL SUSTAINABILITY
The organisation is operationally sustainable. However, it has identified scope to offer more
streamlined services to patients, help to address issues facing the wider systems of care, and to
become more efficient in terms of operational delivery. The strategy has been developed to address
these factors.
The key uncertainties are: Mitigations
 If demand for unscheduled care grows above A key aspect of SCAS’s strategy is an increase
commissioner plans, there is a risk that there is in analytical capability and capacity, so that we
insufficient capacity across systems of care. can make use of the wealth of data that we
This could have a detrimental impact on SCAS have available regarding demand trends and
operational performance if the public use 999 service gaps. The intention is to use this
and 111 as an alternative option, especially if analysis to gain a better understanding of our
SCAS does not have sufficient resources in place own performance and also to offer a
or there is insufficient capacity in other services ‘helicopter view’ of the local systems of care.
to respond to the excess demand.
SCAS will use its assessment and signposting
services to direct patients to the right care,
first time to meet individual needs. This will
help to prevent any increase in demand from
having an onward impact on Emergency
Departments unless appropriate.
We will continue to engage with the public and
undertake ‘misuse campaigns’ in attempt to
encourage people not to use emergency
services inappropriately, and therefore
minimise the risk of any increase in
inappropriate demand.
 If competitive tendering results in the loss of SCAS is actively working to build its bidding
services in some areas, SCAS would have capability and capacity to increase the chance
reduced scope to make optimal use of the of winning and renewing contracts.
resources in that area or to take advantage of
The strategic plan is also to broaden the range
economies of scale. This is most likely to have a
of services offered, so that the risks associated
detrimental impact in rural drive zones, where
with the loss of any single contract are
there is already a single resource and utilisation
minimised.
rates are already low.
 If SCAS cannot recruit, develop and retain There is early work to design a new service
enough clinicians, for either the Clinical model and to create the associated workforce.
Coordination Centres of the mobile healthcare
teams, there is a risk that we cannot fulfil our
operational commitments.
 There is competition to recruit and retain skilled SCAS has a workforce strategy and
clinical staff, both in our Clinical Coordination development plan to ensure that we have the
Centres and for our mobile workforce. Without clinical workforce required.
sufficient clinicians, SCAS is at risk of having to
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convey more patients to emergency
departments instead of assessing clinical needs
and directing them to the ‘right care, first time’.

1.3 FINANCIAL SUSTAINABILITY
The organisation is financially sustainable in its current configuration and service profile.
However, given the predicted growth in demand and reduction in funding, it is prudent to take
action to reinforce the organisation’s long term financial sustainability.

The key factors that have changed and risks for the future are:
 Potential loss of Patient Transport contracts and exit costs, or reduced margins if renewed
 Increasing difficulty in delivering year-on-year cost improvements and downside mitigations
 Clinical Commissioning Groups are increasingly challenged
 Increased competition
The strategic plan is designed to address these issues and secure financial sustainability.

1.4 EVIDENCE BASE
Clinical evidence
SCAS is performing well against the majority of clinical indicators and national benchmarking data. It
has also achieved a ‘clean bill of health’ from the Clinical Quality Commission.
There are short term action plans in place to improve performance in some areas, including care for
patients suffering from stroke or improving use of analgesia for patients suffering heart attack.
Operational evidence
SCAS is performing well against the majority of indicators.
‘Time to treatment’2 and ‘Red 19’3 have been identified as areas needing improvement and it has
long been recognised that these response measures are particularly challenging in rural areas with
low demand. The strategy of developing new mobile healthcare services alongside our emergency
response service should help to address this.
‘Recontact rates’ and ‘frequent callers’ have also been identified as areas for improvement. The
move to NHS Pathways as the tool for assessing 999 calls should help to address the telephone
recontact rates, as patients will not need to call again whilst waiting to be contacted by a clinician.
The introduction of electronic patient records and associated access to the local Directory of Services
should enable clinicians to ensure that their response is tailored to patient needs, with
improvements in both on scene recontact and frequent caller rates.
Financial evidence
SCAS has an excellent track record in terms of financial performance and is sustainable in its current

2 Time for first clinician to arrive on scene
3 Time for conveying vehicle to arrive on scene

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configuration and service profile. However, given the predicted growth in demand and reduced
funding available, action is required to reinforce the organisation’s long term financial sustainability.

1.5 CRITICAL SCHEMES

The key challenges facing SCAS are to improve the quality and effectiveness of patient care and to
support local systems to manage rising demand, within the context of tightening finances. The Trust
has identified five key strategic schemes, designed both to respond to these challenges and to
ensure sustainable high quality services.

The critical enabling schemes to this strategy are outlined below:
 Virtual telephony and resilient technical platform across SCAS
 Ensuring that local Directories of Services are comprehensive, accurate and up-to-date
 Electronic communication and clinical records
 Analytical capability and capacity
 Workforce development (particularly mobile clinicians with advanced skills)
 Technological development (for example tele-monitoring or digital capability)
 Cost transformation programme

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2 MARKET ANALYSIS AND CONTEXT

2.1 LOCAL HEALTH ECONOMIES
2.1.1 Current services
SCAS provides a range of clinical telephone assessment and mobile healthcare services across
south central England.
These include emergency 999 services in Berkshire, Buckinghamshire, Hampshire and Oxfordshire.
We also take referrals from healthcare professionals for urgent clinical transport to and between
healthcare settings and, in addition, we hold various contracts for logistics and commercial training
services in these counties.
Our urgent NHS111 and non-urgent Patient Transport Services cover a slightly wider geography,
including parts of Bedfordshire and Hertfordshire. We have recently taken on some national
contracts, including the national resilience for NHS111 during winter 2013-14, the pandemic flu
service and managing the legacy organisation for NHS Direct.
2.1.2 Challenges and priorities for each local health economy
We have been working with commissioners and partner agencies to explore the challenges facing
each system over the next five years. There are some common themes:
 Manage the growth in demand for unscheduled care
 Integrate services and pathways across health and social care, particularly for the growing frail
elderly populations
 Reduce hospital admissions and length of stay, both for patient benefit and in response to
tightening finances
 Provide more 24/7 services, with focus on improving the ‘out of hours’ provision
These priorities have a number of implications for SCAS, and we need to find ways to:
 Enable patients to identify and access the care that they need first time
 Enable more people to stay safely in their own home or community
 Support efficient and effective patient flow around systems of care
We need to redirect 999 and 111 callers to the most appropriate pathway of care, and only to
convey patients to emergency departments if it is the best place to respond to their clinical needs.
SCAS is working with local commissioners and other services to ensure that the appropriate
pathways of care are in place at the times required. Once developed, it is critical that the various
pathways of care are accurately documented and available through the local Directory of Services
(DOS), and that SCAS clinicians can refer patients directly onto appropriate pathways.
SCAS already has a mobile clinical workforce available on a 24/7 basis. These clinicians are
currently available to respond to emergency calls, offering assessment and treatment at scene if
this is more appropriate than conveyance to hospital. In response to the challenges facing our local
health economies, SCAS is exploring whether this workforce could be utilised to enable more
patients to stay at home safely, by offering an assessment and treatment service to urgent calls
(not just emergency) and by taking referrals from other health care professionals.
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